Ambulatory Blood Pressure Patterns and Left Ventricular Mass Index in Tanzanian Adults Living with and without HIV

TL;DR

People with HIV show reduced nocturnal blood pressure dipping, which is linked to higher heart mass, suggesting office blood pressure measurements may not fully capture their cardiovascular risk.

Contribution

This study quantifies the association between ambulatory blood pressure patterns and left ventricular mass in people with and without HIV.

Findings

PWH had lower nocturnal dipping and higher diastolic non-dipping rates compared to PWoH.

Asleep systolic BP was independently associated with higher LVMI in PWH but not in PWoH.

Office BP measurements may underestimate CVD risk in PWH due to discrepancies with ABPM readings.

Abstract

People with HIV (PWH) experience an increased risk of cardiovascular disease (CVD). Small studies suggest that PWH have less nocturnal dipping, but the clinical importance of this difference is not known.

The aim of this study was to compare ambulatory blood pressure monitoring (ABPM) parameters by HIV status and quantify the effect of ABPM parameters on left ventricular mass index (LVMI) in PWH and people without HIV (PWoH).

We conducted a cross-sectional analysis of enrollment and one-month data from PWH and PWoH from the Mwanza HIV&CVD cohort study. Unattended, automated office BP and ABPM measurements were conducted at two time points and averaged. Regression models, adjusted for CVD risk factors, were used to compare ABPM parameters by HIV status. Twenty-four-hour ABPM patterns were displayed using time series analysis. The association between ABPM parameters and LVMI was tested, controlling for office BP. Analyses were stratified by hypertension status.

Of the 999 participants enrolled, 959 (96.0%) had at least one complete ABPM measurement (483 PWH/476 PWoH). Office BP was higher in PWoH compared to PWH but nocturnal BPs were similar. Nocturnal dipping percentages were lower in PWH. The prevalence of diastolic non-dipping was 41% in PWH compared to 28% in PWoH (incidence rate ratio 1.42 [1.20,1.69]). Differences in dipping patterns and discrepancies between office and ABPM were apparent in time series analysis. Asleep systolic BP was independently associated with LVMI even after adjusting for office systolic BP in PWH, but not in PWoH. PWH had less nocturnal dipping than PWoH and asleep BP was independently associated with higher LVMI in PWH only. These findings suggest that office BP might underestimate the true BP-related CVD risk in PWH.

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